=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710189410
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INTEGRIS URGENT CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/04/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 700 24TH AVE NW
-----------------------------------------------------
City | NORMAN
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73069-6232
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-364-0555
-----------------------------------------------------
Fax | 405-573-5477
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 269032
-----------------------------------------------------
City | OKLAHOMA CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73126-9032
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-951-2298
-----------------------------------------------------
Fax | 405-951-2038
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT
-----------------------------------------------------
Name | MR. BARTON H DAWSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 405-951-2987
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QU0200X
-----------------------------------------------------
Taxonomy Name | Urgent Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------